Salutogenic Housing for Older Adults: The Role of Residential In-Between Spaces on the Environmental Sense of Coherence Among Older Adults (Tehran)

Abstract

The home environment plays a crucial role in supporting the health and well-being of older adults. As populations age, there is a growing emphasis on environmental factors as a non-pharmacological intervention that support health. This study extends the concept of salutogenesis by investigating the relationship between residential in-between spaces and older adults’ environmental sense of coherence. This descriptive-correlational study was conducted with 150 older residents from Shahid Beheshti Township, Tehran. Participants completed questionnaires on their perceptions of in-between spaces and their environmental sense of coherence. Data analysis involved Confirmatory Factor Analysis (CFA) for validation, followed by Pearson correlation and multiple regression. We also assessed the Variance Inflation Factor (VIF) and used k-fold cross-validation to ensure model robustness. Results showed a strong positive correlation between all three in-between space capabilities and environmental sense of coherence: connector (r = .730), separator (r = .771), and integrator (r = .793), all at p < .001. Regression analysis revealed that the integrator capability was the strongest predictor, accounting for 62.7% of the variance in environmental sense of coherence. These findings suggest that in-between spaces, particularly those with features that seamlessly integrate indoor and outdoor environments, are crucial for fostering a sense of coherence and, consequently, promoting health and well-being in older adults. We recommend architectural and design strategies that prioritize physical characteristics such as proportions, scale, and material harmony to achieve this integration.

Plain Language Summary

A Space at Home for the HEALTH of Older Adults

Our homes and neighborhoods play a significant role in maintaining the health of older adults. We examined how specific semi-open spaces (in-between spaces) in a residential complex in Tehran, such as balconies, terraces, porches, and courtyards, provide older adults with a sense of meaning, being understood, and the ability to manage their daily lives. We found that spaces that easily connect indoor and outdoor environments are very important. This means that thoughtful design of these intermediate areas can significantly improve the well-being of older adults and their sense of comfort in their surroundings. Our findings can help architects and urban planners design and create better living spaces for the older adult population.

Keywords

salutogenic environmental sense of coherence (ESOC)in-between space older adults residential town

Introduction

The concept of “home” is a fundamental need for older adults, and its role in the aging process presents a significant challenge. The right of older adults to remain in their homes is a central focus of aging-in-place policies and environmental gerontology research (Zhang et al., 2024). However, the transition of aging presents various challenges to remaining in one’s home. For instance, a person’s residence may become unsuitable for their needs, particularly for those who lack family support or whose health requires specialized care (Gulestø et al., 2025). In these situations, the salutogenic theory offers a promising framework.

The salutogenesis theory, first proposed by Antonovsky in 1979, brought about a significant shift in the perspective on health. In contrast to the traditional pathogenic approach, which focuses on the causes of disease, the salutogenic model aims to identify factors that contribute to health and well-being (Antonovsky, 1979). Antonovsky initially centered his work on the individual’s internal resources, introducing the Sense of Coherence (SOC) as a key internal source of health. The SOC is defined by three criteria: manageability, comprehensibility, and meaningfulness. This means that if an individual finds the situation they encounter in their life experiences and when facing challenges and problems to be manageable, comprehensible, and meaningful, they can healthily overcome that experience (Mittelmark & Bauer, 2022). Antonovsky encouraged researchers to explore other potential sources of health. As research across various disciplines evolved, the connection between the salutogenic SOC and an individual’s physical environment gained scholarly attention. In the field of architecture, the concept of “coherence” was articulated years ago by Kaplan with the term “complexity and coherence” (Seamon & Sowers, 2008) and by Alexander as the “whole environment” (Alexander, 1993; Seamon, 2013). However, its direct link to health outcomes and salutogenesis is a more recent area of focus. Since 2017, criteria for a sense of coherence have been defined through numerous studies on environmental factors and design elements (J. Golembiewski, 2016, 2017). For example, research has examined the relationship between environmental components and the SOC in rehabilitation, therapeutic, and care centers, investigating the impact of nature and natural interventions on creating a sense of coherence and consequently maintaining health (Beute & de Kort, 2014; Dietscher et al., 2017; Dilani, 2006; Langeland & Vinje, 2022; Pelikan, 2022). Despite these advances, less attention has been given to the direct impact of built environments and physical elements on creating a sense of coherence and supporting health, particularly within the residential context of older adults.

While much research on older adults has focused on the design of nursing homes and care centers (Dietscher et al., 2017; Pelikan, 2017), salutogenic design is not limited to these institutional settings. It also has significant potential to create a sense of coherence and support the health of older adults within their own homes, thereby providing a foundation for a high quality of life and enhancing their ability to cope with future challenges (J. Golembiewski, 2010; J. A. Golembiewski & Zeisel, 2022). This approach does not advocate for transforming homes into treatment centers or implementing remote medical control (Sholl, 2017). Instead, it focuses on the health-promoting role that the configuration of a home’s physical elements can play. While the importance of nature and green and blue spaces for promoting health is well-recognized (Zumelzu et al., 2025), older adults spend a significant portion of their time in the enclosed environments of their homes. Therefore, the salutogenic importance of the physical elements within their immediate living environment is amplified.

The definition and form of “home” are profoundly shaped by cultural and social conditions. The meaning of home for older adults is inherently context-dependent, with factors influencing place attachment varying based on cultural, social, and physical environments (Olfat, 2025). Research indicates that a location becomes a home not merely through ownership but through the meaningful and emotional relationships an older adult build with that environment (Gulestø et al., 2025). The creation of this meaning is achieved when an environment provides a context for positive, personal narratives and facilitates interaction with the physical space itself (Boccagni & Duyvendak, 2021), with other people (Andersson et al., 2020; Chaudhury et al., 2018; Naik & Ueland, 2020), and with nature and natural elements (Du et al., 2025; Liu & Gallois, 2022). A review of studies on aging in place (Pani-Harreman et al., 2021; Xia et al., 2024; Zhang et al., 2024) and related topics like mobility and transportation suggests that staying at home is a cornerstone of well-being and health for most older adults. This underscores the importance of understanding how a home environment becomes, or can be designed to be, salutogenic.

A recent systematic review identified that among all residential physical elements, those at the boundary between a building’s indoor and outdoor spaces have a strong conceptual affinity with a sense of coherence. These spaces, by the spatial capabilities they create, can lead to a greater environmental sense of coherence and health promotion (Rakhshani & Khakzand, 2025). These areas are known as in-between spaces (Park, 2015) and typically include entrance elements, terraces, balconies, porches, and yards (Figure 1).

Figure 1.

Schematic layout of in-between spaces in a residential complex.

Given that high-rise residential complexes represent a common form of contemporary housing, this research aims to investigate the relationship between the design of in-between spaces and older adults’ environmental sense of coherence within these environments. Our primary goal is to identify the most effective characteristics of these spaces that contribute to a health-promoting, or salutogenic, home environment. Figure 2 presents the conceptual model of this study, which illustrates the links between environmental salutogenesis and complementary theoretical approaches.

Figure 2.

A conceptual model of research.

In our conceptual model, the in-between spaces of residential units create spatial capabilities—integrating, separating, and connecting—through their location and architectural elements. Positioned at the boundary between indoor and outdoor, or the built and natural environments, these spaces possess specific characteristics such as geometry, form, and proportions. When older adults perceive these capabilities, it leads to a stronger environmental sense of coherence, which in turn supports their health across physical, social, and psychological dimensions.

This model is supported by key concepts from environmental gerontology, particularly the ecology model of aging. Research within this model highlights how an individual’s dynamic relationship with their residential environment, neighborhood, and social networks significantly influences their place attachment and psychological well-being (Daryanto & Song, 2021; Oswald et al., 2024). Oswald and Wahl (2019) identify agency and belonging as two central dimensions of this person-environment interaction. Belonging strengthens emotional bonds and a sense of identity, providing psychological security and connection to the community. Designing environments that balance agency and belonging is thus crucial for promoting well-being and enabling successful aging in place (Cutchin & Rowles, 2024).

The theory of aging in place further supports this view by defining “home” as both a physical and a social place (Gulestø et al., 2025; Zhang et al., 2024). Home provides ontological security by offering stability, control, safety, and a context for personal identity development (Jacobs & Malpas, 2013; Zhang et al., 2024). This multi-faceted function, which fosters a sense of belonging to the community and attachment to the home, directly reinforces the salutogenic concepts of meaningfulness and comprehensibility. By encompassing both physical and social dimensions, the aging-in-place theory provides a strong theoretical foundation for the importance of in-between spaces, which serve as a nexus for both types of environmental interactions.

Research Hypotheses

This study aims to investigate the predictive relationship between older adults’ perception of residential in-between spaces and their environmental sense of coherence, while controlling for key demographic factors. The research hypotheses are as follows:

Hypothesis 1: The perceived capabilities of in-between spaces, including their connector, separator, and integrator functions, will be positively associated with older adults’ environmental sense of coherence.

Hypothesis 2: Among these capabilities, the integrator function will be the strongest positive predictor of environmental sense of coherence.

Method

Method challenges

The method of studying the effects of environmental variables on the health of older adults is very challenging. Despite controlled laboratory environments and tools that provide researchers with modern technology, the effectiveness of these methods is debated due to the specific characteristics of older adults, including their different physical and mental conditions (Luyat et al., 2024; Mu et al., 2023). In a few case studies, the use of virtual reality (VR) in rehabilitation studies and encouraging older adults to engage in physical activity has been described as effective (Charissis et al., 2024; Muñoz et al., 2024), but evidence in other areas is very limited and reports of discomfort in older adults and disruption in research results have been noted (Älmqvist Nae et al., 2024; Li & Muschalla, 2024). Laboratory environments, by increasing anxiety, yield unreliable results (Bogaisky, 2020; Lecomte & Juhel, 2011; Stevens et al., 2008). However, non-laboratory and real environments have provided more reliable research results (S. Y. Chen Zhou, 2011; Laera et al., 2023; K. Schnitzspahn et al., 2020). Therefore, this research was conducted in the real living environment of older adults.

Study Design, Site, and Sampling

The study site was selected based on a preliminary survey of 10 residential complexes in Tehran, with Shahid Beheshti Estate chosen as the primary site due to its fulfillment of specific criteria, including a significant older adult population and a diverse range of in-between spaces. The estate is a mixed-use development with residents primarily from middle-to-upper middle-income strata, providing a suitable context for the study.

Participants were recruited using a combination of random sampling and snowball sampling. Researchers approached older adults in communal areas of Shahid Beheshti Estate, including parks, community centers, and entrances to shopping malls. The inclusion criteria for participation were:

Age 60 years or older.

Independent living within the estate.

Minimum residence period of 5 year in the town

Willingness to participate and ability to provide informed consent.

Absence of acute cognitive illness, ensuring they could understand and complete the questionnaire.

Potential participants received a detailed explanation of the study’s purpose, confidentiality protocols, and their right to withdraw at any time. Informed consent was obtained from all participants before the questionnaire was administered.

A total of 238 older adults were approached for interviews, with 180 agreeing to participate. Of these, 150 participants were ultimately included in the study after meeting all inclusion criteria. The required sample size was determined prior to data collection based on a power analysis conducted using G*Power software. This analysis indicated that a sample of 150 participants would provide 95% power to detect a medium effect size (F² = 0.15) with an alpha level of α = .05 for the planned multiple regression analysis.

Instrument Development

The development of the study questionnaire, which included measures for perceptions of in-between spaces and environmental sense of coherence, followed a meticulously designed process to ensure both theoretical grounding and cultural relevance within the Iranian context.

A comprehensive qualitative phase was conducted from November 2022 to March 2023, prior to the quantitative data collection. This phase was crucial for adapting concepts from the international literature to the specific cultural and environmental conditions of older adults in Tehran. In-depth, semi-structured interviews were conducted with 48 older adults (aged 60 and above) residing in various settings across Tehran, including areas similar to our target study site. The interviews were designed to elicit participants’ lived experiences, perceptions, and interpretations of their residential environment, with a specific focus on elements contributing to “environmental coherence” and the functionality of “in-between spaces.” Key themes and culturally specific concepts emerged from these discussions, which directly informed the refinement, adaptation, and addition of items to the initial drafts of the questionnaire. This iterative process ensured the final instrument was linguistically appropriate, conceptually relevant, and resonated with the daily experiences of older adults in Iran.

In parallel, the “sense of coherence” (SOC) construct, a cornerstone of the salutogenic framework, underwent further cultural localization for the Iranian context. We drew upon the findings of Rohani et al. (2010), who had previously adapted and validated the SOC scale for Iranian populations. Their research guided our conceptual understanding of comprehensibility, manageability, and meaningfulness within the cultural nuances prevalent in Iran (Rohani et al., 2010, 2015).

Following this qualitative phase, the revised questionnaire was developed. All items were initially drafted in English, professionally translated into Persian, and then back-translated into English by an independent bilingual expert to ensure semantic and conceptual equivalence. The final Persian version was then pilot-tested with a small group of 15 older adults, who were not part of the main study sample, to assess clarity, comprehensibility, and administration time. Minor adjustments were made based on feedback from this pilot test before beginning the main data collection

Measures

Data were collected using two primary instruments: a researcher-developed questionnaire on in-between spaces and the Environmental Sense of Coherence Questionnaire (ESOC). Both instruments used a 7-point Likert scale.

In-Between Spaces Questionnaire

This questionnaire, developed by the researchers, was designed to measure older adults’ perceptions of residential in-between spaces. It consists of 33 items organized into three core capabilities, with each capability further broken down into specific components:

Connector (13 items): This capability was assessed through items related to visual connections (6 items), auditory connections (4 items), and connections with nature (3 items).

Separator (7 items): This section included items focusing on privacy (4 items) and security (3 items).

Integrator (13 items): This capability was measured using items on proportions and scales (6 items), harmony in form (3 items), and harmony in materials (4 items).

All items were based on a thorough literature review, as detailed in Table 1. The questionnaire used a 7-point Likert scale, with responses ranging from 1 (strongly disagree/very low) to 7 (strongly agree/very high). The total score for this questionnaire ranged from 33 to 231. A higher score indicates greater satisfaction with the design components of the in-between spaces. Items 7 and 9 were reverse-scored.

Table 1.

Capabilities, Components, and Items Evaluated in the In-Between Space Questionnaire.

Capability	Component	Items	References
Connector	Visual connection	1–6	Dovey and Wood (2015), Elsheshtawy (2013)
	Auditory connection	7–10	Azhar et al. (2020)
	connection with nature	11–13	Rembeza and Sas-Bojarska (2022)
Separator	Impermeability and Privacy	14–17	Gehl et al. (2006)
Separator	Safety	18–20	Gehl et al. (2006), Dovey and Wood (2015)
Separator	Physical properties	21–25	Salima et al. (2023), Rembeza and Sas-Bojarska (2022)
	Geometric form	26–29	Azhar et al. (2020), Rembeza and Sas-Bojarska (2022), Elsheshtawy (2013), Yin and Wang (2016)
	Architectural and esthetical values	29–33	Azhar et al. (2020)

Environmental Sense of Coherence (ESOC) Questionnaire

The ESOC questionnaire was used to measure the outcome variable. This instrument is an architectural extrapolation of the standard Sense of Coherence (SOC-29) questionnaire, formulated according to J. A. Golembiewski’s (2022) definitions. It comprises 28 items across three components:

Manageability (12 items)

Comprehensibility (8 items)

Meaningfulness (8 items)

The ESOC also used a 7-point Likert scale, with responses ranging from 1 (very low) to 7 (very high). Scores on this questionnaire ranged from a minimum of 28, indicating a low sense of coherence, to a maximum of 196, representing the highest level of environmental sense of coherence. Details of this questionnaire can be found in Supplemental Material 2.

Validity and Reliability

The validity and reliability of the research instruments were established through a multi-step process. Content validity was first confirmed by a panel of eight experts, including professors from the fields of architecture, educational sciences, and psychology. Their review ensured that the questionnaires accurately measured the intended constructs and were relevant to the study’s objectives.

For construct validity and reliability, a Confirmatory Factor Analysis (CFA) was performed for each questionnaire. Items with factor loadings below the threshold of 0.4 were removed from the model. We then assessed the model’s reliability using both Cronbach’s alpha and Composite Reliability (CR), with the results presented in Table 2. Finally, convergent and discriminant validity were confirmed using the average variance extracted (AVE > 0.5) and the Heterotrait-Monotrait (HTMT < 0.9) ratio. These results collectively support the psychometric soundness of the questionnaires.

Table 2.

Demographic Characteristics of the Participants.

Variable	N	Percentage	Range	Mean	SD	Total
Gender
Male	76					50.66%
Female	74					49.33%
Age			64–80	69.69	3.17
Male
Female			60–78	69.32	3.32
Education level
High school diploma
Male	20	13.3				26%
Female	19	12.66				26%
Associate degree
Male	16	10.66				21.33%
Female	16	10.66				21.33%
Bachelor’s degree
Male	31	20.66				37.33%
Female	25	16.66				37.33%
Master’s degree
Male	9	6.00				15.3%
Female	14	9.33				15.3%
Self-reported health
Excellent
Male	20	13.3				30%
Female	25	16.66				30%
Good
Male	28	18.66				38.66%
Female	30	20				38.66%
Fair
Male	28	18.66				31.33%
Female	19	12.66				31.33%
Poor	0					0

Data Collection Procedure

After obtaining ethical approval, the primary researcher conducted a detailed field survey of Shahid Beheshti Estate. This involved neighborhood zoning, mapping the high-rise residential complexes, and a categorization of the existing in-between spaces within the estate (Figure 3).

Figure 3.

Residential complexes studied in Shahid Beheshti Town.

Subsequently, data were collected from older adult residents through the administration of the questionnaires. Participants completed the questionnaires individually. In cases where a participant had difficulty reading or writing, the researcher administered the questionnaire orally and recorded their responses. The maximum time for completion was approximately 30 min.

All questionnaires were completed fully, and no data dropouts or losses were observed during the collection process, resulting in a 100% completion rate for the final sample.

Data Analysis

All statistical analyses were performed using SPSS and R software. Prior to hypothesis testing, the Kolmogorov-Smirnov test was conducted to assess the normality of the data distribution. We then checked for multicollinearity by calculating Variance Inflation Factor (VIF) coefficients. The VIF values for the independent variables ranged from 1.096 to 4.068, and for the dependent variable components, they ranged from 1.346 to 4.409. As all values were below the common threshold of 5, multicollinearity was not a significant concern for the model.

The relationships between variables were first examined using the Pearson correlation coefficient. Subsequently, a multiple regression analysis was conducted to investigate the predictive relationship between the perceived capabilities of in-between spaces and the environmental sense of coherence, after controlling for relevant demographic factors. To enhance the robustness and generalizability of our predictive model, we also employed k-fold cross-validation.

Ethical Consideration

This research and its methodology were reviewed and approved by the Research Ethics Working Group of University.

In adherence to ethical guidelines, no interventions were conducted in this study. All participants provided their informed consent before participating. Prior to the administration of the questionnaires, the purpose of the research was explained to the older adults, and they were informed that their participation was entirely voluntary. They were assured that the collected data would be kept strictly confidential and used exclusively for research purposes. Participants were also explicitly informed of their right to withdraw from the study at any point without penalty and were assured that their responses to demographic questions would not contain any identifying information.

Result

Based on the conducted survey, four types of spaces, including terrace, balcony, yard, and porch, were categorized as in-between spaces, and the residential complexes under study had at least one of these types (Figure 4).

Figure 4.

Schematic section and plan of in-between spaces and its relationship with the surroundings in Shahid Beheshti Town residential complexes.

Sample Demographics and Preliminary Analyses

The demographic characteristics of the participants are presented in Table 2. The final sample of 150 older adults was relatively homogeneous across age, gender, education, health status, and socioeconomic and cultural backgrounds.

Descriptive statistics for the research variables (mean, standard deviation) are detailed in Table 3.

Table 3.

Descriptive Statistics of the Research Variables.

Variables	Min	Max	Mean	Standard deviation
Visual connection	1.17	7	4.32	1.21
Auditory connection	1.75	5.75	3.40	0.71
Connection with nature	2	7	5.52	1.44
Connector	2.47	6.25	4.41	0.88
Impermeability and privacy	1.50	7	4.65	1.55
Safety	3	7	5.62	1.08
Separator	2.25	7	5.09	1.21
physical properties	1.83	5.67	3.77	0.77
Geometric form	2.33	7	4.93	1.16
Architectural and esthetical values	1	6.75	3.53	1.23
Integrator	2.03	6.08	4.08	0.93
In-between space	2.48	6.18	4.46	0.87
Manageability	1.58	7	4.82	1.38
Comprehensibility	2.75	7	4.25	0.74
Meaningfulness	1.25	7	3.87	1.32
ESOC	2.38	6.83	4.31	1.02

The assumption of data normality was tested using the Kolmogorov-Smirnov test. As shown in Table 4, the significance level (Sig.) for all research variables was greater than .05, confirming that the data were normally distributed.

Table 4.

Output of the Kolmogorov-Smirnov Test.

Variable	Z	Sig
Connectivity	0.859	.452
Separation	1.09	.184
Integration	0.854	.459
In-between space	0.629	.825
Manageability	1.224	.100
Comprehensibility	0.812	.524
Meaningfulness	1.248	.089
ESOC	0.765	.603

Validity and Reliability of the Instruments

The psychometric properties of the questionnaires were assessed using Confirmatory Factor Analysis (CFA). The results of the CFA indicated a good fit for the models, with the SRMR index being 0.056 for the in-between space questionnaire and 0.057 for the ESOC questionnaire (both <0.08). The NFI values were also acceptable, at 0.850 for in-between spaces and 0.870 for ESOC (both approaching 1).

The reliability and convergent validity of the scales were also confirmed. As presented in Table 5, the Cronbach’s alpha and Composite Reliability (CR) values for all scales were above the recommended threshold of .7, while the Average Variance Extracted (AVE) values exceeded the .5 threshold, confirming convergent validity.

Table 5.

Reliability and Validity Indices of the Factor Analysis Model of Questionnaires.

Measures	Hidden variable	Cronbach’s alpha > .7	CR > 0.7	AVE
In-between space	In-between space	0.937	0.944	0.502
	Connector	0.880	0.905	0.520
	Visual connection	0.910	0.943	0.848
	Auditory connection	0.824	0.894	0.737
	Connection with nature	0.739	0.852	0.659
	Separator	0.861	0.896	0.560
	Safety	0.764	0.866	0.686
	Impermeability and privacy	0.799	0.872	0.639
	Integrator	0.859	0.888	0.516
	Physical properties	0.756	0.802	0.522
	Geometric form	0.708	0.793	0.566
	Architectural and esthetical values	0.720	0.827	0.550
ESOC	Environmental sense of coherence	0.955	0.961	0.557
	Comprehensibility	0.826	0.869	0.529
	Manageability	0.948	0.956	0.645
	Meaningfulness	0.881	0.913	0.646

Correlation Analysis

The relationships between the in-between space capabilities and the Environmental Sense of Coherence (ESOC) were examined using the Pearson correlation coefficient. As shown in Table 6, all correlations were positive and statistically significant at the p < .001 level.

Table 6.

Correlation Coefficients (Pearson’s r) of the Relationship Between the Variables of In-Between Spaces and ESOC.

Variable	Manageability	Comprehensibility	Meaningfulness	SOC
Variable	r	r	r	r	Sig
Visual connection	.365	.608	.579	.563	.001
Auditory connection	.382	.257	.433	.423	.001
Connection with nature	.641	.463	.610	.666	.001
Connector	.615	.596	.710	.730	.001
Impermeability and privacy	.782	.435	.695	.760	.001
Safety	.712	.364	.522	.636	.001
Separator	.818	.441	.678	.771	.001
Physical properties	.786	.500	.583	.729	.001
Geometric form	.711	.398	.592	.675	.001
Architectural and esthetical values	.710	.481	.624	.708	.001
Integrator	.824	.515	.681	.793	.001

The correlations between the individual components of connector capability and ESOC were as follows: visual connection (r = .563), auditory connection (r = .423), and connection with nature (r = .666).

For separator capability, the correlation coefficients for privacy (r = .760) and security (r = .636) with ESOC were both positive and significant.

The components of integrator capability also showed strong positive correlations with ESOC: physical characteristics (r = .729), geometric form (r = .675), and material harmony (r = .708).

At the capability level, the overall correlation coefficients with ESOC were r = .730 for connector, r = .771 for separator, and r = .793 for integrator, all of which were highly significant (p < .001).

Regression Analysis

A multiple regression analysis was conducted to predict ESOC based on the perceived capabilities of in-between spaces. The results of the stepwise regression are presented in Table 7.

Table 7.

Summary of Regression Analysis for Predicting Environmental/Architectural Coherence Based on the In-Between Spaces Capability.

Step		Component	r	R ²	F	Unstandardized coefficients		Standardized coefficients	T	Sig
Step		Component	r	R ²	F	B	Std. error	Beta	T	Sig
Connector	1	Connection with nature	0.666	0.444	118.11	0.47	0.043	0.666	10.87	.001
	2	Connection with nature +visual connection	0.716	0.513	77.28	0.362 0.256	0.047 0.056	0.512 0.304	7.67 4.55	.001 .001
	3	Connection with nature +visual Connection + Auditory connection	0.732	0.545	56.05	0.317 0.248 0.238	0.049 0.055 0.089	0.449 0.295 0.165	6.45 4.50 2.67	.001 .001 .008
Separator	1	Impermeability/Privacy	0.760	0.578	202.33	0.496	0.035	0.760	14.22	.001
Separator	2	Impermeability/Privacy + safety	0.777	0.603	111.62	0.399 0.206	0.047 0.067	0.610 0.219	8.65 3.07	.001 .001
Integrator	1	Physical properties	0.729	0.531	167.78	0.960	0.074	0.729	12.95	.001
	2	Physical properties + Geometric form	0.786	0.617	118.59	0.608 0.327	0.091 0.057	0.462 0.397	6.69 5.57	.001 .001
	3	Physical properties + Geometric form + Architectural and esthetical values	0.803	0.645	88.48	0.523 0.225 0.211	0.091 0.063 0.063	0.397 0.273 0.241	5.72 3.58 3.38	.001 .001 .001

For the Connector Components, the final model included connection with nature, visual connection, and auditory connection. Together, these three components accounted for 54.5% of the variance in ESOC (R² = .545). Connection with nature was the strongest predictor, explaining 44.4% of the variance alone (R² = .444).

For Separator Components, the final model, which included privacy and security, collectively explained 60.3% of the variance in ESOC (R² = .603). Privacy emerged as the stronger predictor, accounting for 57.8% of the variance.

For Integrator Components, the final model, which included physical characteristics, materials, and geometric form, explained 64.5% of the variance in ESOC (R² = .645). Physical characteristics was the strongest initial predictor, explaining 53.1% of the variance.

Hierarchical Regression Analysis

To investigate the effects of in-between space components on ESOC while controlling for demographic variables, a second-order hierarchical regression analysis was performed. In the first step, control variables (age, health status, and gender) were entered the model. In the second step, the in-between space capability variables (connector, separator, and integrator) were added. The results of the two models are presented in Table 8.

Table 8.

Summary of Two Regression Models Examining the Effect of Control Variables on ESOC.

Model		Unstandardized coefficients		Standardized coefficients	t	Sig	Collinearity statistics
Model		B	Std. error	Beta	t	Sig	Tolerance	VIF
1	Constant	214.15	52.98		4.04	.000
	Gender	−3.93	4.65	−0.067	−0.84	.399	0.985	1.015
	Age	−1.51	0.73	−0.167	−2.05	.042	0.937	1.067
	Health	7.91	3.06	0.211	2.58	.11	0.927	1.079
2	Constant	−1.87	29.07		−0.06	.949
	Gender	−0.32	2.33	−0.006	−0.14	.88	0.973	1.027
	Age	−0.10	0.37	−0.012	−0.28	.77	0.87	1.141
	Health	0.76	1.57	0.020	0.48	.626	0.875	1.143
	Connector	0.74	0.12	0.288	5.82	.000	0.625	1.60
	Separator	0.99	0.22	0.297	4.50	.000	0.350	2.857
	Integrator	1.05	0.17	0.412	6.16	.000	0.342	2.927

The first model, which included only the control variables, was significant at the p < .01 level. Of the control variables, only age and health status had a significant effect on ESOC (p < .05), while the effect of gender was not significant (p = .399).

The second model, which included the in-between space capabilities, was also highly significant (p < .01). With the control variables in the model, all three in-between space capabilities—connector, separator, and integrator—were found to be significant predictors of ESOC (p < .01). This demonstrates that the effect of these capabilities is significant even after accounting for the influence of age and health status.

Changes in Variance Explained (R²)

As shown in Table 9, the control variables alone explained a small portion of the variance in ESOC (R² = .099). When the in-between space components were added in the second step, the total variance explained increased to a high value of R² = 0.782. The change in R² (ΔR² = .683) indicates that the in-between space components, after controlling for demographic variables, uniquely account for 68.3% of the variance in ESOC. This is a significant contribution and underscores the strong predictive power of these spaces.

Table 9.

Changes in R² Due to the Inclusion of Predictor Variables.

Model	R	R ²	Adjusted R²	Std. error of the estimate	R² change	Change statistics
Model	R	R ²	Adjusted R²	Std. error of the estimate	R² change	F change	df1	df2	Sig. F change
1	.314^a	.099	.080	28.304	.099	5.337	3	146	.002
2	.884^b	.782	.772	14.080	.683	148.99	3	143	.000

Predictors: Age, Gender and Health.

Predictors: Connector, Separator and Integrator.

Model Validation

To check for multicollinearity, the Variance Inflation Factor (VIF) was calculated for all predictor variables. The VIF values for the in-between space components ranged from 1.346 to 2.409, for the ESOC components, they ranged from 1.346 to 4.409, and for control variable from 1.015 to 1.14. As all values were below the common threshold of 5, multicollinearity was not a significant concern.

Finally, a k-fold (5-fold) cross-validation was performed to test the model’s stability and generalizability. The results for the final regression model showed an R² value of .771 and an RMSE of 13.836. The minimal change from the original model’s R² (.778) and RMSE (14.101) indicates that the model is stable and generalizable beyond the current sample.

Discussion

The in-between space, by its unique physical characteristics and spatial placement at the boundary of indoor and outdoor environments, creates distinct capabilities. The findings of this study confirm a strong positive correlation between these capabilities and older adults’ environmental sense of coherence. The three key capabilities, connector, separator, and integrator, provide a context for health-promoting behaviors, thereby serving as an external source of health. The specific degree of correlation for each component with the sense of coherence is detailed in Figure 5.

Figure 5.

Comparison of correlations between components of in-between space and sense of coherence.

As shown in Figure 6, integrator capability exhibited the highest correlation with environmental sense of coherence. It is compelling to note that this finding aligns with Alexander’s (1993) earlier concept of “wholeness,” where he argued that designing integrated and interactive indoor-outdoor spaces creates a strong sense of place. Decades later, valuable research has demonstrated that a sense of belonging and agency are crucial for older adults’ well-being (Cutchin & Rowles, 2024; Oswald & Wahl, 2013, 2019). Our findings further complement this understanding by establishing that this sense of belonging is directly aligned with an environmental sense of coherence and, crucially, is significantly predicted by the integrator capability of in-between spaces.

Figure 6.

Comparison of the correlation coefficients (r) of in-between space capabilities with the environmental sense of coherence.

The successful integration of indoor and outdoor environments is paramount for creating a coherent architectural experience (Dai, 2021; Obeidat, 2020). This seamless relationship not only enhances a space’s esthetic appeal but also positively shapes older adults’ perceptions of their environment (Behzadi, 2022; Purnama & Pane, 2021). This perspective challenges the traditional view of a house as a purely closed environment designed to minimize the need for movement. Instead, we argue that while the indoor space provides a foundation for balance in an older adult’s life, the roles of the outdoor and in-between spaces—which serve as a gateway and a communication link between the two—are equally vital and cannot be overlooked.

As illustrated in Figure 6, separator capability was the second strongest predictor of environmental sense of coherence. An intriguing finding is the apparent contradiction between the high correlations of both integrator and separator capabilities. This suggests that in-between spaces simultaneously address two seemingly contradictory needs: the desire for social integration and the need for privacy. Specifically, the perception of privacy was more highly correlated with the sense of coherence than the perception of security.

This result, though from the specific cultural and climatic context of Iran, is consistent with the findings of Brown et al. (2009). While many studies emphasize the importance of social connections for older adults, our results align with research indicating that older adults are often dissatisfied with constant exposure and a lack of privacy (Mu et al., 2023; Tao et al., 2018; Yang et al., 2020). Our analysis of in-between space components revealed that in spaces with visual breaks, such as recesses or light walls, the correlation between privacy and environmental sense of coherence was particularly high (Figure 5).

Furthermore, separation demonstrated the strongest correlation with the manageability component of the sense of coherence (r = .818). This suggests that having privacy empowers older adults to maintain control over their space, a finding consistent with the ecology model of aging within environmental gerontology. Research by Oswald and Wahl (2019) highlights that older adults desire not only a sense of belonging but also agency, or the ability to be an active operator within their environment. Agency is crucial for maintaining independence, autonomy, and self-efficacy. Conversely, belonging fosters emotional attachment, identity, psychological security, and community connection (Olfat, 2025). Together, a balance between these two fundamental needs—agency and belonging—forms a robust foundation for older adults’ health and successful aging in place.

Connector capability was identified as the third significant predictor of environmental sense of coherence (Figure 6). Among its components, the connection with nature within the in-between space demonstrated the strongest correlation (Figure 5). This finding is consistent with a vast body of literature that highlights the connection between nature and health (Y. Chen et al., 2022; Kabisch et al., 2017; Zhifeng & Yin, 2021).

Specifically, within residential contexts, our results align with research by Von Lindern et al. (2017) and Beute and de Kort (2014), underscoring the vital role of providing opportunities for older adults to connect with nature, whether through direct access or a natural view. This is further supported by studies that have revealed the positive impact of the sensory and tactile perception of natural elements on psychological well-being (Zumelzu et al., 2025) and the physiological benefits, such as decreased blood pressure and enhanced relaxation, associated with feelings of naturalness (Du et al., 2025).

Therefore, the thoughtful design of in-between spaces—by incorporating elements such as views of natural landscapes and the sky, strategic placement for optimal airflow, and the use of materials with natural textures—is crucial for enabling older adults to benefit from a deeper connection with nature.

Loneliness and the need for care are among the primary reasons older adults are transferred from their homes. Social isolation, often stemming from feelings of disconnection, poses a significant threat to their physical, mental, and social health (Olfat, 2025). Spaces designed for communication and interaction with the outdoor environment, however, can substantially mitigate this isolation (Clark et al., 2024; Daryanto & Song, 2021; Lebrusán & Gómez, 2022).

From a social perspective, the concept of “home” extends beyond the physical dwelling to include neighborhood connections and intergenerational relationships (Zharani & Selim, 2023). As individuals age, their desire for indirect interactions, such as visual and auditory communication, often increases (Luo et al., 2022; L. Xu, 2024; H. Z. Xu et al., 2024). These forms of interaction can be as simple as observing community activities, children playing in a park, or neighbors and friends passing by (Boccagni & Duyvendak, 2021; Daryanto & Song, 2021). The phrase “street eye,” coined by Brown et al. (2009), highlights the concept that visual communication from behind a window can effectively reduce social isolation and mitigate depressive symptoms.

The in-between space serves as a vital context for these behaviors. It acts as a progressive semi-open environment that is both personally owned and manageable, yet simultaneously facilitates interaction with the surroundings. This unique blend allows older adults to engage with their community on their own terms—they can see and hear without being seen, or retreat to privacy whenever desired, thereby preventing unwanted interactions. In this way, the in-between space creates meaningful connections while remaining a controllable and manageable environment. The full relationship between the capabilities of these spaces and the environmental sense of coherence is presented in Figure 6.

Limitation

This study’s findings should be interpreted considering several limitations. First, as cultural factors profoundly influence design preferences, social norms, and the very concept of “home,” the relationships observed here may not be directly generalizable to other contexts. The sense of belonging, for instance, can be experienced differently in a collectivist versus an individualist society, or in cultures with varying approaches to aging. Similarly, the specific architectural and design typology of Shahid Beheshti Estate, a high-rise residential complex, may not be representative of other housing forms. In-between spaces in traditional or rural homes may be defined differently, possessing unique physical characteristics that could affect the components of form, proportion, and esthetics.

Because of this, we emphasize that the key takeaway of our research lies in the concept of spatial capabilities (integrator, separator, connector), rather than the specific design elements themselves. To generalize these findings, future research should explore how alternative architectural elements in different regional contexts can create these same capabilities. Additionally, as noted by Gulestø et al. (2025), socioeconomic status can affect access to quality housing and perceptions of safety and belonging. While our sample was relatively homogeneous in this regard, these factors could influence the strength or nature of the relationships observed in other populations.

A second major limitation is the cross-sectional design of this study. While we found strong correlations and predictive relationships, this methodology does not allow for inferences of causality. We can, therefore, only suggest a strong association between specific design features of in-between spaces and an improved environmental sense of coherence. To establish a causal relationship, future research should employ longitudinal designs that can capture changes in environmental perception and sense of coherence over time in response to architectural interventions or changes.

Practical Implications

Our findings have significant practical implications for architects, urban planners, and aging-policy professionals who are committed to creating supportive living environments for older adults.

For Architects and Designers

Architects should prioritize the integrator function when designing in-between spaces. The strong predictive power of this capability suggests that seamless connections between indoor and outdoor environments are crucial for enhancing a sense of coherence. We recommend designing expansive transition areas, living spaces with excellent views of green areas, and balconies that feel like extensions of the home. To further strengthen this integration, designers should strategically use natural light, textures, and proportions to increase the sense of meaningfulness, manageability, and comprehensibility of these spaces.

For Urban Planners

Urban planners should implement policies that encourage the development of integrated residential communities. These policies should include clear guidelines for creating well-designed public and semi-public in-between areas. Planners can facilitate a stronger sense of community by mandating the inclusion of green spaces, communal gathering points, and pedestrian-friendly pathways that encourage social interaction and connection with nature within residential complexes.

For Aging-Policy Professionals

Professionals in aging policy should champion funding and initiatives that support the development and renovation of age-friendly housing. Their advocacy should emphasize the crucial role of effective in-between spaces in these projects. Additionally, policies that promote community engagement in the design process would ensure that these spaces are tailored to the specific needs, preferences, and cultural contexts of older residents.

Conclusion

This study produced two key findings regarding the role of in-between spaces in promoting a salutogenic home environment for older adults.

First, spaces such as terraces, balconies, porches, and courtyards are far more than just inanimate structures; they are vital links between older adults and their living environment. They facilitate a continuous interaction with the world by enabling communication and engagement with their surroundings. These spaces provide the essential context for behaviors that support health and well-being. Therefore, the physical elements of in-between spaces can promote an Environmental Sense of Coherence (ESOC), thereby serving as an external source of health for older adults.

Second, our research indicates that specific design components of in-between spaces are critical for creating this salutogenic quality. The most impactful of these is the integrator function, which promotes a seamless connection between indoor and outdoor environments. Architects should prioritize designing spaces with appropriate human proportions, area, and height to allow for movement and use. Additionally, attention to material textures, quality, and formal harmony between indoor and outdoor spaces can significantly increase an individual’s sense of coherence.

While integrator capability was the strongest predictor of ESOC, the importance of privacy, a key component of the separator capability, cannot be overlooked. The high correlation between privacy and ESOC suggests that in-between spaces must also offer older adults control over their interactions and provide a sense of personal security. This highlights a crucial balance in design: fostering social connection while respecting the need for personal autonomy.

Our findings also expand upon the existing literature by showing that a salutogenic home environment is not solely dependent on a connection with nature. While a connection with nature remains important, this study demonstrates that other physical characteristics of in-between spaces—such as proportions, materials, security, and spatial form—can also play a significant role in fostering a sense of coherence.

This research, while powerful, is not without limitations. Its cross-sectional design prevents causal claims, and its focus on a specific high-rise context in Iran limits the generalizability of the findings. The conceptual model proposed here, however, can serve as a framework for future study. We recommend that subsequent studies employ longitudinal designs and conduct cross-cultural comparisons to test the universality of our findings. Further study could also explore the impact of in-between spaces on individuals with disabilities or specific cognitive illnesses like Alzheimer’s, as well as examine different residential typologies. Finally, the conceptual links revealed between salutogenesis, aging in place, and environmental gerontology warrant more detailed exploration in future studies.

Supplemental Material

sj-docx-1-sgo-10.1177_21582440261447587 – Supplemental material for Salutogenic Housing for Older Adults: The Role of Residential In-Between Spaces on the Environmental Sense of Coherence Among Older Adults (Tehran)

Supplemental material, sj-docx-1-sgo-10.1177_21582440261447587 for Salutogenic Housing for Older Adults: The Role of Residential In-Between Spaces on the Environmental Sense of Coherence Among Older Adults (Tehran) by Zohre Rakhshani, Mehdi Khakzand and Naser Nastiezaie in SAGE Open

Footnotes

Acknowledgements

The researchers feel it is necessary to express their utmost gratitude and appreciation to all those who collaborated in making this study better, especially older adults.

ORCID iD

Zohre Rakhshani

Ethical Considerations

This research and its methodology were approved by the Research Ethics Working Group of Iran University of Science and Technology under number IR.IUST.REC.1402.018. It is worth mentioning that we had no intervention in this study.

Consent to Participate

All participants provided their informed consent verbally before participating. Prior to the administration of the questionnaires, the purpose of the research was explained to the older adults, and they were informed that their participation was entirely voluntary. They were assured that the collected data would be kept strictly confidential and used exclusively for research purposes. Participants were also explicitly informed of their right to withdraw from the study at any point without penalty and were assured that their responses to demographic questions would not contain any identifying information.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All data generated or analyzed during this study are included in this article.

Supplemental Material

Supplemental material for this article is available online.

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Supplementary Material

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Salutogenic Housing for Older Adults: The Role of Residential In-Between Spaces on the Environmental Sense of Coherence Among Older Adults (Tehran)

Abstract

Plain Language Summary

Keywords

Introduction

Research Hypotheses

Method

Method challenges

Study Design, Site, and Sampling

Instrument Development

Measures

In-Between Spaces Questionnaire

Environmental Sense of Coherence (ESOC) Questionnaire

Validity and Reliability

Data Collection Procedure

Data Analysis

Ethical Consideration

Result

Sample Demographics and Preliminary Analyses

Validity and Reliability of the Instruments

Correlation Analysis

Regression Analysis

Hierarchical Regression Analysis

Changes in Variance Explained (R2)

Model Validation

Discussion

Limitation

Practical Implications

For Architects and Designers

For Urban Planners

For Aging-Policy Professionals

Conclusion

Supplemental Material

sj-docx-1-sgo-10.1177_21582440261447587 – Supplemental material for Salutogenic Housing for Older Adults: The Role of Residential In-Between Spaces on the Environmental Sense of Coherence Among Older Adults (Tehran)

Footnotes

Acknowledgements

ORCID iD

Ethical Considerations

Consent to Participate

Funding

Declaration of Conflicting Interests

Data Availability Statement

Supplemental Material

References

Supplementary Material

Changes in Variance Explained (R²)